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Author’s reply to the Letter to the Editor from Mungunpuntipantip and Wiwanitkit
Article
Dear Editor,
I read with interest the letter by Mungmunpuntipantip R. and Wiwanitkit V. about our reported case of a livedoid reaction to the second dose of mRNA COVID-19 vaccine. I agree with their saying that because of the minimal information on the health and immunological status of vaccine recipients prior to inoculation, determining the precise etiology of a clinical problem may be difficult, and a clinical comorbidity could be the source of the problem detected by the COVID-19 vaccine. Eventually, they suggested that the livedoid reaction described could be attributable to an asymptomatic COVID-19 infection at the time of vaccination. However, we clearly reported that the patient repeatedly tested negative in the early period before and after the vaccination 1. Even with the caveat that rapid antigenic tests yield a high specificity but suboptimal sensitivity, repeated testing should be taken as reasonably reliable of the patient’s immunologic status. Moreover, even if sparse, there is increasing evidence in published literature that a reaction with clinical appearance of livedo reticularis could be part of the spectrum of skin reactions to COVID-19 vaccine, both with BNT162b2 mRNA vaccine such as in our case 2, with the other mRNA vaccine by Moderna company 3 and also with the AstraZeneca/Oxford (ChAdOx1) vaccine which implies another mechanism of action 4,5. Therefore, we stand with our interpretation of the case, at the same time being aware of the challenges in clinico-pathological correlation in such cases.
CONFLICT OF INTEREST
The author declares no conflict of interest.
FUNDING
None.
References
- Girolami I, Eisendle K, Kluge RW. Livedoid skin reaction to 2nd dose of mRNA Covid-19 vaccine. Pathologica. 2022; 114:322-325. DOI
- Horino T, Inotani S, Nakajima K. Livedo Reticularis After COVID-19 Vaccination. J Rheumatol. 2023; 50:709-709. DOI
- Mintz MA, Jariwala N, Fang V. Livedo reticularis on bilateral knees after the third dose of messenger RNA-1273 SARS-CoV-2 vaccine. JAAD Int. 2022; 7:52-53. DOI
- Kränke T, Cerpes U, Legat F. Rezidivierende Livedo-artige Hautveränderungen nach einer Vektor-basierten COVID-19-Impfung. Die Dermatologie. 2023; 74:614-617. DOI
- Kim JH, Uh JA, Kim HS. Livedo reticularis following administration of ChAdOx1 nCoV-19 vaccine (AZD1222): a report of two cases. Clin Exp Vaccine Res. 2022; 11:298. DOI
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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© Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology , 2023
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